Pilonidal Care Program | Treatments

Antibiotics and hygiene: Sometimes when a pilonidal abscess first shows up, the doctor treats it with antibiotics and suggests better hygiene, such as shaving and soaking/showering the infected area.

Drainage of abscess: If the pilonidal abscess is not draining on its own, it may need to be drained in a doctor’s office or emergency room. To drain the abscess, the doctor may:

Numb the area with local anesthesia

Make a small cut in the abscess to allow the pus to drain

Cover or pack the abscess with dressing or gauze

Give you instructions on how to care for the abscess at home

Pilonidal disease can come back.If your child has had one abscess, there is a 50:50 chance that the pilonidal disease may come back in the future.

Home Care
Hair removal and hygiene are the two key things you have to do if you want pilonidal disease to go away - and improve chances of it not coming back.
Hair RemovalLaser hair removal: Laser hair removal is one of the treatment modalities offered at the Pilonidal Care Clinic at Boston Childrens Hospital. Most cases of Pilonidal Disease occur because there is too much hair in the gluteal crease. Often, the hair can be excessive, and cannot be managed by shaving alone. If the medical team determines that your child would benefit from laser hair removal, they will recommend this treatment to you as an option to consider. Instructions on what to do to prepare for laser treatment will be emailed to you prior to your visit.
Laser hair removal is a safe procedure performed in the office by our PA or surgeon. You will be scheduled for a longer visit than usual (around 1 hour). When your child arrives, they will be seen and examined as usual. If it is safe to proceed with laser hair removal the day of the visit, one of our clinicians will shave the area apply local anesthesia cream. Your child will wait 30-45 minutes for the anesthetic cream to take effect. The treatment is performed in the treatment room of the clinic. If patients agree, parents can be present, but everyone in the room must wear special safety goggles. A laser hand-piece will deliver laser energy in approximately 1 inch increments to the area that needs to be treated (the buttock crease and 2 inches on either side). This treatment can cause mild discomfort but is usually well tolerated. The entire treatment takes around 2-3 minutes. When your child’s treatment is finished, instructions will be given about signs and symptoms of complications (uncommon and usually temporary), and do’s and don’ts after treatment.

Your child will need at least 6 laser treatments for permanent or near-permanent hair removal. Treatments are 6-8 weeks apart. Waiting too long between treatments will cause your child to need extra laser treatments, so it is important to plan for a schedule of timely laser treatments. Hair is the cause of almost all pilonidal disease. Any type of hair can cause problems, but the most troublesome is coarse, thick hair. Hair removal is the most important thing you can do for your pilonidal disease.

It is important to cut the hair VERY short

Make sure you remove ALL of the hair in the area around the butt crease. Even one hair can keep the cut from healing or can make a new abscess show up. A family member will most likely need to help with hair removal.

How to remove hairs:

Shaving: You may need to do this every week, depending on how thick hair is and how fast it grows. To remove hair from the area, use regular razors, electric beard trimmers, or eyebrow shapers.

Chemical hair removal: You may use NairTM or other hair removal creams and gels to keep the hair away longer. Make sure to do not get the cream into the cut or on your anus.

Hygiene

You need to clean away all of the bacteria, debris, loose hairs and sweat on the skin of the buttock crease. You can do this by:

Soaking in a bath for 10 to 15 minutes, two to three times a day.

Spraying the buttock crease with a hand-held shower head for 10 to 15 minutes, two to three times a day.

Sitting in a Jacuzzi, pool or ocean for 10 to 15 minutes, two to three times a day.

Surgical Treatments

There are surgical treatments that may help pilonidal disease. Talk to your doctor to see what is right for you or your child.

Operation: Some patients may need to have an operation to take care of their pilonidal disease. The surgery takes place under general anesthesia in the operating room. Your surgeon discusses the best surgical option for your child’s situation. There are three general types of operations:

Remove the infection and close the cut: The surgeon removes the pilonidal abscess, tracts and the infected fat and skin. He or she only leaves the healthy tissue behind, and closes the cut with stitches. This operation makes the pilonidal abscess go away the fastest, but there is a real chance that the abscess may come back after the operation.

Remove the infection and leave the cut open: The surgeon removes the pilonidal abscess, tracts and the infected fat and skin, but keeps the skin of the cut open and filled with gauze. This allows the cut to heal from the inside out. This operation takes longer to heal than closing the cut, but makes it less likely for the abscess to come back later.

Flaps: The surgeon removes the pilonidal abscess, tracts and the infected fat and skin. He or she uses healthy skin, fat, and muscles from another part of the buttocks to fill up the space where the abscess was. This can be a complicated operation, but is a good option in some people when other things have not worked well.

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